Transplanting Diabetic Kidneys Better Than Remaining on Waitlist

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Overall, recipients of diabetic donor kidneys had a 9% lower chance of dying compared with remaining on the waitlist.

Transplanting “high-risk” diabetic donor kidneys provides a survival advantage over staying on the waitlist for many candidates, researchers reveal.

Using the Organ Procurement and Transplantation Network database, Jordana B. Cohen, MD, MSCE, of the University of Pennsylvania in Philadelphia, and colleagues compared 8101 recipients of diabetic donor kidneys and 126,560 recipients of nondiabetic donor kidneys who underwent surgery following the first diabetic donor kidney transplant in 1994.

Over a median follow-up of 8.9 years, the mortality rate was 35 deaths per 1000 person-years, according to results published online ahead of print in the Clinical Journal of the American Society of Nephrology. Recipients of diabetic donor kidneys had 9% lower odds of dying from any cause compared with patients who stayed on the waitlist indefinitely or ultimately received a non-diabetic donor kidney.

“When accepted by appropriate candidates, diabetic donor kidneys have the potential to shorten waitlist times, and ideally reduce the risk of death on the waitlist,” Dr Cohen and the team stated. Patients with high mortality risk with long wait times appear to benefit most, they added. This group includes people with diabetes. In contrast, recipients of diabetic donor kidneys who were younger than 40 years experienced no survival benefit from diabetic donor kidneys.

Notably, using marginal diabetic donor kidneys carried risks. Diabetic donor kidneys with a more than 85% score on the Kidney Donor Profile Index (KDPI) offered no survival benefit. Among all high-KDPI donor kidneys, kidneys from diabetic donors were associated with worse mortality than those from non-diabetics.

In the United States, the need for donor organs continues to outpace the supply. In an accompanying editorial, Richard N. Formica Jr., MD, of Yale University School of Medicine in New Haven, Connecticut, highlighted that this study offered important evidence for use of deceased donor kidneys that would otherwise be rejected.